Introduction to Addiction, The Next Step

Isabel Byon 0:00

The New York State Office of Addiction Services and Supports , or OASAS , provides this podcast as a public service . Opinions expressed do not necessarily reflect those of the agency or state . This is Addiction: The Next Step .

Jerry Gretzinger 0:21

Hey everybody , Jerry Gretzinger , your host for Addiction: The Next Step here , brought to you by the New York State Offices of Addiction Services and Supports , and if you've tuned in and checked out our podcasts in the past or if you've watched the video versions on YouTube , you know we're in a different space today . We're actually on location , because what we're doing this is something that we're really excited to do and it's to share some of the good work that's being done with the opioid settlement dollars . I'm sure people are familiar at this point with the opioid settlement funds the money that's come in to states around the nation to help with the opioid crisis , the overdose crisis , and there is a lot of great work that's being done with those dollars , and today we get to explain one of the many things that that's helping to support

Explaining Low-Threshold Buprenorphine Programs

Jerry Gretzinger 1:03

. And joining us today to talk about this program we're going to profile are Regina Hernandez . She is here . She's the Network Director of Addictions Programs with the Westchester Medical Center . We appreciate you sitting down with us . We also have Lauren Taliaferro .

Jerry Gretzinger 1:18

Taliaferro right , Lauren Taliaferro , there's a lot of syllables in that second one , I'll make sure I get it right . But you are a social worker who works with the program . So , ladies , thanks so much for sitting down with us today .

Jerry Gretzinger 1:29

So we are , we're here at the Westchester Medical Center and we're talking about something that's called a low-threshold buprenorphine program , and I was mentioning to you before we started recording that I think for those of us who work in this area , we say the words low threshold buprenorphine and we know we just say , oh , it's low threshold bup . Okay , we understand . But I think for a lot of people out there I mean , there's so many different types of treatments and avenues people can take when they're looking for help with a situation like this , they may go , yeah , okay , it's not the treatment . But so let's start before we talk about the specific program here . What does that mean ?

Regina Hernandez 2:04

When we say low-threshold buprenorphine , so what that means in a nutshell is providing easy access to services , not only low-threshold buprenorphine but other forms of MAT outpatient treatment , recovery services .

Jerry Gretzinger 2:20

MAT medication-assisted treatment .

Regina Hernandez 2:20

Medication-assisted treatment, yep . Basically meeting people where they're at , seeing what services could benefit them . Person-centered care . Letting the patient person who is encountering us in the program lead the discussion and help them navigate what services would work best for them .

Jerry Gretzinger 2:36

And so by low threshold we mean that this is like an easy avenue for them to be able to access this

Regina Hernandez 2:41

Lowest barriers

Jerry Gretzinger 2:42

Right . And again for people who may not know , because again we make a lot of assumptions , buprenorphine is a medication that that helps with this addiction to substances , if you can just kind of expand on that a little bit

Regina Hernandez 2:54

Absolutely . So, buprenorphine is one of a variety of medication assisted treatments that people use to treat their substance use disorder . People utilize buprenorphine in many formats . There is the popular brand name , but also people can use it in films , tablets , there is injectable formulations of buprenorphine , and basically it helps people maintain their recovery and a lot of people choose that as their primary form of treatment . But they also might use that in combination with other forms of treatment , such as if they're needing withdrawal and stabilization services , inpatient rehab , outpatient services , peer supports . So it is not a one-size-fits-all . It's very much tailored to the individual's needs .

Jerry Gretzinger 3:45

Right , I mean . So obviously you know the kind of . The key deliverable here is the treatment with buprenorphine .

Regina Hernandez 3:50

Mm-hmm .

Jerry Gretzinger 3:51

But I think what is unique I think now that this is becoming more I don't want to say commonplace , but probably more of a practiced delivery is the whole low threshold aspect of it , and Lauren , I mean talk about that being able to offer it low threshold

Breaking Down Barriers to Treatment

Jerry Gretzinger 4:11

right . So basically , we're moving a lot of the barriers that are often in place of someone accessing this right .

Lauren Taliaferro 4:17

Absolutely and to piggyback off of what Regina was saying is , in the past , buprenorphine , which is a medication it's been hard to get it to the patient , so there used to be many providers who were not willing or able to give the medication , and so there's been a very direct focus to make this easier for our patients because , you know , if you have a headache it shouldn't be so hard to get Tylenol type of thing . And that's kind of what the view is is how can we better service our patients and our community at large ? This , unfortunately , is something that is happening across the country , and so it's awesome that there is more of a push to improve education , improve , you know , kind of the treatment that our patients are receiving , because we understand there's been a lot of it just hasn't been the way it should have been . So part of what I do here at the hospital is I work directly in the ER and we have patients who come to our ER looking for treatment and that may be inpatient , whether they need stabilization as they are trying to get to that next part of their recovery where they are abstaining and maintaining their sobriety . So patients come into our ER for a plethora of reasons . They may be looking for access to services they may just have questions of . I've never been in this circumstance before . What do the next steps look like ? They may need medication to keep them safe in that moment , and so , inherently within this project and within this program , low-threshold buprenorphine just means get in here and let's see how we can help you .

Lauren Taliaferro 5:59

And so for some patients it will be an admission to an inpatient program , such as here at our hospital , Westchester Medical Center , specifically our Mid-Hudson Regional Campus .

Lauren Taliaferro 6:09

For some patients , I will be referring them to an outpatient office where they can maintain that medication and maybe also receive counseling services . For other patients , they may just need a listening ear and some validation and some person-to-person encouragement of it is okay , you are not in this alone . And so we've been allowed to kind of , you know , really tailor what we're doing to each patient's needs , because everybody comes in and in a different circumstances , everybody's life has looked differently , and so we now have the ability to treat our patients as such , whereas in the past it was kind of a lot more blanketed . And so we've been given such a great opportunity and we've been seeing the effects of it . We've seen a decrease in , you know overdoses in our community . We've seen patients coming in and being treated with kindness and respect and in turn that has had necessary and wonderful effects again in our hospital , in our facility , but again also our community at large .

Jerry Gretzinger 7:11

All right , so I'm going to jump in there . So I think it's . I appreciate the breadth of that response because when I say you know what is low threshold buprenorphine and how does it help people , you went so far beyond the explanation of what buprenorphine does , right .

Jerry Gretzinger 7:25

Because , that's the whole low threshold piece of it . There is everything that you could possibly imagine tied to this . It's making that connection with the people who need these services , and I think one of you said whatever they need , wherever they're at , we're going to meet them , we're going to help them . Buprenorphine is just one piece of that whole puzzle . But to go back to that too , I think there's often people who will say , okay , well , if somebody has been using a substance , how does another substance help them to kind of break that connection right ? So I mean , I know , but I'd rather have one of you explain how it works for people at home . So somebody comes in , they're a candidate for buprenorphine treatment . What does it do to help them break that connection , that cycle they've been in ?

Regina Hernandez 8:13

So for many people it helps them maintain what normality is for them a normal level . So a lot of times the way I explain it is if somebody is diabetic , right , they take medication right to help them maintain a healthy level . Medication-assisted treatment for people with substance use disorder is very similar . They're taking medications not to replace one substance for another , but to achieve a level of normalcy for them , a level of what makes them able to function at a comfortable level , to live their lives , to have a quality of life , and whatever that quality of life means is up to them , and we support that with the services we provide . So medication-assisted treatment , in whatever form , is meant to not so much replace as to support and enhance somebody's quality of life .

Jerry Gretzinger 9:07

And you know , I think too . I think , now that we have these treatments available , they are making such an impact . And , Lauren , again I'm going to go back to you because I know you have a lot of direct interaction with the folks who come in here seeking this and benefit from it . What sort of and I think you were starting to get at this when I jumped in before but what sort of changes are you seeing in the people's lives who've come in and said , okay , I want to do this , I want to make a change and have been able to use this treatment to their advantage ?

Impact on Patients' Lives

Lauren Taliaferro 9:45

Yeah , so the first thing that comes to mind is patients feel a lot more informed and like a participant in their care . So , based on the education they're given , they understand exactly what this medication is . To kind of speak to what you were saying before . Regina said it's not to replace but to support and assist in their recovery .

Lauren Taliaferro 10:02

So they're tailoring so these medications do not necessarily have like psychoactive you know impacts or anything to that regard , but when patients come in , they are now able to know exactly what's going on . They have more of a voice in their care of I do want this medication or I don't want this medication , or I want to go this route , and so there's a lot more independence and involvement and because of that , you know again , we're seeing that patients are feeling they're leaving much more satisfied and much more on board with their plan , and so that means going forward . You know , aftercare and follow-up appointments are met and , you know , maintained at a much higher rate than they were in the past . Patients also , if they do fall off and we understand that can sometimes happen on our journeys .

Lauren Taliaferro 10:53

There's much less shame and judgment when they do return to us , and so they're able to say , Lauren , I fell off the horse . What do we do next ? And we say , okay , today is a new day , you know , let's start with where we're at . So , again , it's given our patients and our staff an ability to again be more person-centered , rather than necessarily specifically focused on treatment or medication or something of that sort .

Jerry Gretzinger 11:18

How many ? I mean , it's been what 14 months that we've been doing this program here , right Approximately ? How many people you've seen come in and be able to take advantage of this ?

Lauren Taliaferro 11:29

I alone have had about 700 encounters .

Jerry Gretzinger 11:31

Wow , 700?

Lauren Taliaferro 11:33

Yes , sir .

Jerry Gretzinger 11:34

I mean that's a lot . I mean we talk about the opioid sentiment dollars being broken up over the state of New York and what the good it can do . 700 people here in this one program

Lauren Taliaferro 11:43

Yes , sir .

Jerry Gretzinger 11:45

That's terrific . And the range of people coming in I'm sure all ages and different walks of life .

Lauren Taliaferro 11:52

All ages , so our specific program is geared towards adults . So I've seen 18 year olds , but also up until we've seen people in their 80s . We've seen people from different demographics , as in race , cultural backgrounds , religions , socioeconomic degrees and statuses . So literally no two patients are alike . But once again , once we're able to get down to the nitty gritty of the person and really , you know , peel those layers back of the onion . A lot of our patients have had similar circumstances , even though they look different , and so again we're able to kind of tailor you know what ? How specifically can we assist you where you are in your life and it won't look the same as the next person treatment , and I enjoy that about it . It's very , um , very tailored . But you would , you would couldn't imagine . Everybody in life has needed some assistance and I'm glad we're able to do it regardless of the circumstances yeah ,

Jerry Gretzinger 12:48

And then 700 of them

Opioid Settlement Funds in Action

Jerry Gretzinger 12:50

right now .

Jerry Gretzinger 12:50

So far , that's in counting that's in counting and so you know .

Jerry Gretzinger 12:54

Then , Regina , I'm going to pop back to you too . You know , one of the things that we at OASAS are happy about , we're proud of , is the amount of settlement dollars we're able to get out as quickly as we got out there some . There are some states , for whatever reason it might be , they've had the dollars . They're still waiting to get most of them out the door . Would this program be what it is without those settlement dollars to help getting it to this point ?

Regina Hernandez 13:20

Absolutely not . I think that's why we're incredibly thankful for giving the opportunity to use these funds for low-threshold buprenorphine , primarily because having Lauren in the ED really expands our outreach . It allows us to touch more people in their greatest time of need . When we think about our workflow for how we plan to use the low-threshold buprenorphine opioid settlement fund dollars was really wanting to meet people at their greatest time of need , which a perfect example is the emergency department . People are coming in for a variety of reasons . Primarily , a lot of our patients , because they know we have an inpatient program , might be seeking services here , but other people might have experienced an overdose . Some people might just have indicators that would make them need substance use treatment services and and for that reason we have Lauren in there .

Jerry Gretzinger 14:09

So , yeah , so again , ladies , I want to thank you for sitting down and chatting with us about this today , Just one of the many programs these funds are helping to support , and the difference that it's making , that you are helping to make , is just tremendous . We're so excited to be able to be a small part of what's happening here , and you know . Best luck for continued success with this . It's changing a lot of lives and that's amazing .

Lauren Taliaferro 14:36

Thank you ,

Regina Hernandez 14:37

Thank you

Jerry Gretzinger 14:37

All right , so listen this was a great conversation we had

Closing Resources and Contact Information

Jerry Gretzinger 14:41

today .

Jerry Gretzinger 14:41

Hopefully it was informative for you . If you want to learn more about the Opioid Settlement Fund and the dollars that are available , what it's supporting , or you just want to find out how you can access treatment like this , you can go to our website . It's oasas . ny . gov , o-a-s-a-s , dot N-Y , dot . G-o-v and , of course , if you want to talk to somebody right now , it's our hope line 877-8-HOPE-N-Y . 877-8-HOPE-NY . I'm your Jerry Gretzinger for Addiction: The Next Step . Until we see you again next time . Be well .